Publication: Anevrizmatik subaraknoid kanama cerrahisi sonrası sıvı-elektrolit bozuklukları
Abstract
Bu çalışmada anevrizmatik subaraknoid kanama nedeni ile kraniyotomi uygulanan ve yoğun bakım ünitesinde takip edilen olgularda serebral kaynaklı sıvı-elektrolit bozukluklarının sıklığı ve yoğun bakım ünitesindeki yatış süresi üzerine etkileri araştırıldı. ASA II-III grubu, anevrizmatik subaraknoid kanama nedeniyle kraniyotomi uygulanan olguların yoğun bakım ünitesi kayıtları retrospektif olarak incelendi. Anevrizmanın yeri, serum sodyum değeri ve osmolalitesi, idrar miktarı ve dansitesi, parenteral ve enteral alınan sıvı miktarı, santral venöz basınç değeri ve yoğun bakım ünitesi yatış süreleri kaydedildi. Serum sodyum değeri < 130 mEq L-1, serum osmolalitesi < 270 mOsm kg-1 ve idrar dansitesi >1010 mg dL-1 olan olgular hiponatremik, serebral tuz kaybı grubu (Grup S); serum sodyum değeri > 145 mEq L-1, serum osmolalitesi > 295 mOsm kg-1, idrar dansitesi < 1005 mg dL-1 ve poliürik olgular hipernatremik, diabet insipid gru-bu (Grup D); serum sodyum değeri 130-145 mEq L-1, serum osmolalitesi 270-295 mOsm kg-1 olan olgular normonatremik, grup normal (Grup N) olarak sınıflandırıldı. Grup S (% 9.4)'deki olguların yoğun bakım ünitesi yatış süresinin (22.33±14.04 g) Grup D (% 34.4) (8.0±4.2 g) ve N (% 56.2) (6.38±2.50 g)'den belirgin uzun olduğu saptandı (p<0.01). Grup S'nin serum osmolalite (263.0±5.0 mOsm kg-1) değerleri diğer gruplardan belirgin düşük bulundu (p<0.001). Orta sereb-ral arter anevrizmasına bağlı subaraknoid kanama olgularında Grup S (% 22.2) ve D (% 22.2)'nin görülme sıklıkları arasında fark bulunmazken, ön kominikan arter olgularında Grup D (% 40)'nin görülme sıklığı, Grup S (% 6.6)'den daha yüksek bulundu. Sonuç olarak anevrizmatik subaraknoid kanama nedeniyle kraniyotomi uygulamaları sonrasında serebral kaynaklı sıvı-elektrolit bozukluklarının sık olarak görüldüğü, vazospazm, serebral ödem, konfüzyon, konvülziyon ve koma gibi nörolojik bozukluklara yol açarak altta yatan patolojinin kötüleşmesine neden olabileceği unutulmamalı ve elektrolit değerleri yakından takip edilmelidir.
In this retrospective study we aimed to demonstrate the incidence of cerebral originated-fluid and electrolyte disturbances and evaluate the diagnostic and treatment modalities in patients who underwent craniotomy for subarachnoid hemorrhage and aneursym clipping. We investigated the intensive care unit charts of patients ASA I-II, who underwent craniotomy for aneurysm clipping retrospectively. Serum sodium level and osmolality, urine density, total amount of fluid infused, urine output, central venous pressure, location of aneurysm and the days spent in the intensive care unit were evaluated. Patients were divided into 3 group; hyponatremic patients with serum sodium values <130 mEq L-1, serum osmolality <270mOsm kg-1 and urine density > 1010 mg dL-1 were called as Group cerebral salt wasting (Group S); hypernatremic patients with serum sodium values >145mEq L-1, serum osmolality >295 mOsm kg-1, urine density <1005 mg dL-1 and polyuri were called as Group diabetes insipidus (Group D) and normonatremic patients with serum sodium values 130-145, SOsm 270-295 mOsm kg-1 and urine specific gravity >1010 mg dL-1 were called as Group normal (Group N). The days spent in the intensive care unit were longer in Group S (9.4 %) (22.33±14.04 days) than Groups D (34.4 %) (8.0±4.2 days) and N (56.2 %) (6.38±2.50 days) (p<0.01). Serum osmolality in Group S (263.0±5.0 mOsm kg-1) was lower than the other groups (p<0.001). According to the location of aneurysm, there were no difference at the incidences of Group S (22.2 %) and D (22.2 %) in aneurysm of middle cerebral arter. The incidence of Grup D (6.6 %) was found higher than Group S (6.6 %) in aneurysm of anterior communican artery. In conclusion, we decided that electrolyte imbalance was seen in patient with subarachnoid hemorrhage frequently and might cause deterioration of underlying pathology results from vasospasm, cerebral edema, confusion, convulsion and coma. Therefore volume status and electrolyte imbalances must be taken into consideration in patients operated for SAH/aneurysm and its proper management must be performed.
In this retrospective study we aimed to demonstrate the incidence of cerebral originated-fluid and electrolyte disturbances and evaluate the diagnostic and treatment modalities in patients who underwent craniotomy for subarachnoid hemorrhage and aneursym clipping. We investigated the intensive care unit charts of patients ASA I-II, who underwent craniotomy for aneurysm clipping retrospectively. Serum sodium level and osmolality, urine density, total amount of fluid infused, urine output, central venous pressure, location of aneurysm and the days spent in the intensive care unit were evaluated. Patients were divided into 3 group; hyponatremic patients with serum sodium values <130 mEq L-1, serum osmolality <270mOsm kg-1 and urine density > 1010 mg dL-1 were called as Group cerebral salt wasting (Group S); hypernatremic patients with serum sodium values >145mEq L-1, serum osmolality >295 mOsm kg-1, urine density <1005 mg dL-1 and polyuri were called as Group diabetes insipidus (Group D) and normonatremic patients with serum sodium values 130-145, SOsm 270-295 mOsm kg-1 and urine specific gravity >1010 mg dL-1 were called as Group normal (Group N). The days spent in the intensive care unit were longer in Group S (9.4 %) (22.33±14.04 days) than Groups D (34.4 %) (8.0±4.2 days) and N (56.2 %) (6.38±2.50 days) (p<0.01). Serum osmolality in Group S (263.0±5.0 mOsm kg-1) was lower than the other groups (p<0.001). According to the location of aneurysm, there were no difference at the incidences of Group S (22.2 %) and D (22.2 %) in aneurysm of middle cerebral arter. The incidence of Grup D (6.6 %) was found higher than Group S (6.6 %) in aneurysm of anterior communican artery. In conclusion, we decided that electrolyte imbalance was seen in patient with subarachnoid hemorrhage frequently and might cause deterioration of underlying pathology results from vasospasm, cerebral edema, confusion, convulsion and coma. Therefore volume status and electrolyte imbalances must be taken into consideration in patients operated for SAH/aneurysm and its proper management must be performed.